How Hospital Leadership During the Global Covid-19 Pandemic Enabled Resilient Response to the Changing Need for Care

What We Did

Leading during normal times is often a daunting task, especially in hospitals where many decisions are indeed life or death. However, the Global Covid-19 Pandemic (pandemic) presented hospital leaders with a particular challenge: to sustain their resilience while every decision was being made under the cloud of a crisis. How hospital leaders, operating with humility, navigated during this time to bring out the best in their teams, to continue to deliver on the promise of exceptional care and to do it in such a way that enabled them to come to work ready to take on that day’s new challenges was a once in a lifetime opportunity to study crisis leadership in action.

In a qualitative and follow-up quantitative study, 30 US hospital executives were interviewed, and 360 hospital executives were surveyed over the period 2020–2021. We investigated how hospital leader behavior affected team performance and organizational response and resilience during the pandemic. We sought to understand the conditions around which certain leadership behaviors (such as humility) were expressed and how the hospital’s organizational structure and network facilitated or inhibited collaboration and the ability to absorb change (absorptive capacity). Hospitals whose cultures facilitated collaboration were able to take in rapidly changing data while transforming it quickly into information and knowledge that could be readily disseminated to each other. They seemed to perform better with regard to the availability of staff (clinicians), supplies (PPE), and their ability to leverage their collective capital.

What We Found

The role and behavior of the hospital leader was examined as an antecedent to team performance and organizational resilience during the pandemic. Leadership humility, agility and curiosity were found to be predictors of resilience as defined as being relatively unaffected by the pandemic and as expressed by greater collaboration, coordination, communication, and cooperation among hospital teams. The presence of the capability to take in change, and to interpret and disseminate it quickly both within the hospital as well as within the local network that the hospital was part of served to amplify the effect of leadership and collaboration on overall resilience (at the hospital and at the system level).

The Conceptual Model

The Theoretical Model

Why It Matters

From the research we learned that certain leadership behavior during a crisis is crucial to organizational resilience and that recruiting for this talent (humility, agility and curiosity are not easily trained) as well as developing it further among current leaders is essential for a hospital to be better prepared for the next crisis. Collaboration, and shared leadership while often strong enablers of team performance was not as significant as an organization’s Absorptive Capacity skills. Especially during the pandemic, when information was changing rapidly, the ability for a hospital and its leaders to adeptly manage and respond to change was crucial. This is an area where team development could make a difference through scenario and response planning as well as by examining the best practices already in place to achieve clinical excellence and outcomes to be leveraged by the non-clinical functions of a hospital.

Applying Our Findings

An application for this research might be to provide a way to optimize healthcare practices in a crisis while minimizing risk. This could be tested through gamification by using the model in a ‘mixed game’ where players have different interests and different incentives. It could also be tested as a repeated game with the same actors but different scenarios. Or it could be tested where the outcome of the game is an emergent property of the players’ interactions. Finally, once thoroughly tested, the model could be applied in a real world setting with real data to see if resilience holds up. One assumption could be that the sustainability of a system is the additive value of the resilience of all of the individual players and organizational actors. This could be tested after the pandemic through an analysis of how well an individual city did during the course of the pandemic as a measure of each of the individual entities’ resilience.

Future Research

Keywords: hospital, leadership, crisis, collaboration, resilience, pandemic response, change